Orthopedic Coding Alert

Question: A patient came in with a Lisfranc fracture in their left foot so the orthopedist performed an open reduction and internal fixation (ORIF) of the right foot Lisfranc fracture and tarsometarsal joint. She also performed a closed reduction and perc pinning of third tarsometatarsal joint and removed three pins through separate incisions. How should I report these procedures?

New Jersey Subscriber

Answer: Report the following codes.

• 28615 (Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed)
• 28485-59 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each; Distinct procedural service)
• 28606 (Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation)

You report code 28615 to represent the ORIF of the tarsometatarsal joint. This code considers the whole joint to be one unit because Lisfranc fractures are often accompanied by the displacement of the metatarsals and a fracture at the base of the bones. This code is typically only report if the fracture was not at the level of the TMT joint or was of a different metatarsal.

To account for the internal fixation of the fractures, you will use code 28485. Because work has to be done on each metatarsal bone, you must append modifier 59 to this code in order to account for the distinct services.

Finish off your code with 28606. You use this code to account for the closed reduction and the pinning in the third metatarsal. You should know that you don’t need any follow up codes to report the removal of pins. This procedure is inclusive in 28606. You will need modifier 59 on this code as it bundles with 28615.